Muco- Disorders - Lichen Planus Flashcards
What age range is typical for lichen planus?
30-50 years old
What are different clinical presentations of lichen planus?
BED PR
Reticular Plaque like Erosive Bullous Desquamative gingivitis
How does lichen planus present?
Symmetrical and bilateral
What is lichen planus?
Type IV hypersensitivity - cell mediated auto-immune condition
Risk with lichen planus?
1-3% risk of malignant change
Do see skin involvement in lichen planus?
Less 10% of those with oral lesions have skin lesions
50% of those with skin lesions have oral lesions
What skin lesions see in lichen planus?
Purple, itchy papules
Wickham’s striae on shins
See on flexor surface wrist/ shins
What are other mucosal sites lichen planus can affect?
Oseophageal
Genital
Anal
What is koebner phenomenon in lichen planus?
Pt develops vesicles along scratch lines
What histology do you see in lichen planus?
Blue cells close to epithelium = lymphocytes - indicate autoimmune condition
What is pathology of lichen planus?
Band like accumulation T lymphocytes
Cell mediated damage to basal cells
Disruption basmenet membrane
What happens if rate of damage exceeds rate of repair?
Epithelial thinning - erosive lesions/ ulcerations
What happens if rate of repair exceeds rate of damage?
Epithelial thickening and keratinisation
Reticular and plaque like lesions
What is lichenoid reaction?
Lesions that look like oral lichen planus but no antigenic cause
What pathology of lichenoid reaction?
Band like infiltrate and epithelial damage
Cause of lichenoid reactions
Graft vs host disease
Contact sensitivity
Reaction to systematic drugs
SLE
When is graft vs host seen?
Usually in bone marrow transplant
What is graft vs host disease?
As pt had bone marrow transplant T cells not own - regard keratinocytes as foreign
What is most common material to have contact sensitivity reaction with?
Amalgam
What to do if suspect lichenoid reaction due material?
Lesion will be closely associated w/ filling
Pt needs patch test
Removing/ replacing restoration will resolve lesion 3-6 months
Difference between OLP and OLR?
OLP: symmetrical, bilateral, may have skin lesions
OLR: unilateral, asymmetrical, don’t involve skin, closely related amalgam/ drug
Treatment of OLP?
Topical agent - difflam (benzydamine)
Topical corticosteroids - prednisolone
Topical immunosuppressants - retinoids
Systemic immunosuppressant - azathioprine
Management OLR?
Remove or tx underlying cause
If lesion doesn’t regress - tx for OLP
